Saphenoperitoneal shunt for intractable ascites

Ascites usually complicates chronic liver disease, and some patients with ascites are refractory to medical treatment. Recently, saphenoperitoneal shunt [SPS] was described to treat this condition. This procedure avoids the insertion of a foreign expensive shunt into the circulation. We present our experience with this procedure with some modification in the technique. We performed a prospective study on 11 patients with intractable ascites admitted to the Vascular Unit, Suez Canal University Hospital, Egypt from June 2001 to October 2003. We divided the long saphenous vein approximately at 15 cm distally. We turned the proximal cut end upwards and tunneled under the skin towards the midline in the suprapubic region where we anastomosed it to the peritoneum. One patient died from liver failure 8 days after the operation. Two patients died during follow-up, one at 3 months from liver failure, and the other at 4 months from variceal hemorrhage. We lost one patient to follow up. Seven patients remained alive with patent shunt up to 6 months follow up. The SPS is a safe and effective procedure in the management of intractable ascites

Dramatic vascular course of Behcet's disease

Vascular involvement in Behcet's disease is rare approximately 14% venous and 1.6% arterial, serious and recurrent. We report a case of Behcet's disease with deep venous thrombosis and right iliac pseudoaneurysm which was repaired with polytetrafluoroethylene PTFE graft. The patient received warfarin, aspirin, clopidogrel, immunosuppressive and corticosteroids. Two months later the patient developed manifestations of superior vena cava thrombosis and the graft was blocked. Three months later, ischemia of the right foot deteriorated and left femoral artery to right femoral artery crossover PTFE graft was performed

fast track arterial duplex ultrasound performed by vascular surgeon. Is the now?

With the technologic advancement in vascular ultrasound imaging, surgeons are now encouraged to perform their own examinations. The vascular surgeons run the vascular laboratory in Suez Canal University hospital.The aim of this study to determine the efficiency and advantages of the arterial duplex scanning performed by the surgeon. A prospective comparative study between the results of colour duplex [performed by vascular surgeon], arteriogram and operative finding in 105 limbs [96 lower and 9 upper] from 63 patients, with chronic arterial occlusive disease or peripheral arterial emergencies, was performed. The arterial vessels were divided into 13 segments. A total of 858 segments were examined. Duplex scan was able to detect significant disease with sensitivity 83%, specificity 100% positive predictive index 100%, negative predicative index 93%, accuracy 95% and K value of 0.85. Accuracy for final therapeutic decision was 83% in arteriography, 80% in duplex and combination of both was 100%.Surgeon performed duplex is reliable and should be an integral part of vascular surgeon's practice. Our practice recommends performing arteriogram as well in the lower limb to maximize preoperative information. This paper is accepted for presentation in the first congress of the North African and Middle East chapter of the international union of angiology. Cairo, Egypt- October 2001

Early results of taivt trial

During the last decade few studies have been accomplished in the use of catheter directed thrombolysis for iliofemoral deep venous thrombosis to remove the thrombus completely and rapidly. These studies have shown that early thrombolysis preserve valve function and reduce the incidence of post phlebitic syndrome. However, no large randomised study has addressed its benefits, compared with those of anticoagulation. The aim of our study is to do a prospective randomised study comparing local Thrombolysis and Anticoagulant in Iliofemoral Venous Thrombosis [TAIVT trial] as regard venous function. Consecutive series of patients admitted to Suez Canal University hospital with ileofemoral DVT and comply with the inclusion criteria. Patients were randomised for either catheter directed thrombolysis using streptokinase as thrombolytic agent followed by anticoagulant or anticoagulant alone. Follow up of both arms of the trial will be at 6 weeks then 3 and 6 months post-treatment. At each follow up appointment, assessment of the venous function using colour duplex, air plethysmography and photoplethysmography.We had complete data from only 35 patients, 17 had anticoagulant and 18 had thrombolysis. At 6 months, patency rate was better in cases treated with thrombolysis, complete patency [13patients [72%] versus 2[12%], p < 0.001] and non patency [0 versus 7 [41%], p < 0.001]. Venous reflux was higher in-patients treated with anticoagulant [7 patients [41%] versus 2 [11%], p < 0.042]. Early results of the trial showed that patients treated with catheter directed thrombolysis have better venous function those with anticoagulant. This paper was presented at the XV European Surgical Vascular Society ESVS Conference. Lucerne Switzerland- September 2001

Incidence and surgical intervention of nonatherosclerotic peripheral vascular occlusive diseases in North East of Egypt

Nonatherosclerotic peripheral vascular occlusive diseases in North East of Egypt havn't been reported before. The aim of this study is to search for these diseases. A prospective study on all patients admitted to the vascular unit, Suez Canal University hospital, with peripheral occlusive vascular disease since September 2000 was performed. In addition to all routine laboratory and radiological investigation, ESR and C-reactive protein were tested. A segment of the occluded artery was removed during surgical intervention and sent for histopathological examination. If the specimen showed evidence of arteritis, anti neutrophil cytoplasmic autoantibodies [ANCAs] were tested in the serum.Sixty two patients were included in this study, 52 had positive inflammatory markers and 38 [61%] had histopathological evidence of vasculitis. In the latter group there were 6 [16%] female, 32 [84%] male, median age 45.5 years and all had negative ANCAs. Femoro-popliteal bypass was performed in 17 patients, femorodistal bypass in 9 patients, popliteodistal bypass in 5 patients, axillo-brachial bypass in one patient and primary amputation in 6 patients. There is a high incidence of medium and small sized arteritis in patients with peripheral occlusive disease with negative ANCAs. Routine check up for inflammatory marker in patients with chronic occlusive arterial disease is mandatory. The value of medical treatment to restrain thrombotic progression of the arterial lesions and overall prognosis needs further studies. This paper was presentated at the North African and Middle East chapter of the International Union of Angiology. Cairo, Egypt- October 2001